VitaminBlog.com

Healthnotes Newswire (July 31, 2008)—Premature babies are at risk for complications in their mental development, but new evidence shows that their brains may get a boost from fatty acids: A study in Pediatrics reports that breast milk supplemented with omega-3 DHA (docosahexaenoic acid) and omega-6 AA (arachidonic acid) may improve brain development in premature infants.DHA and AA are two types of fatty acids essential for many bodily functions including brain, eye, and nervous system development. The optimal amounts of these fatty acids for premature infants has not been determined, but researchers suggest that increasing the amounts in early infancy may reduce the risk of developmental problems later in life.

Learning disabilities and school-related problems are more common among premature infants than full-term infants. Prior studies, however, have shown that premature infants who are breast-fed have higher IQs than babies receiving formula milk. This finding was attributed to higher concentrations of DHA found in human milk compared with formula milk. The authors of the new study considered the possibility that increasing the DHA content of human milk and adding AA could further improve preemies’ brain development.

Study results encouraging

In the study, 141 premature infants weighing less than 1,500 grams (about 3 pounds) were randomly assigned to receive human breast milk supplemented with either 32 mg of DHA and 31 mg of AA per 100 ml of milk, or breast milk supplemented with soy oil and medium-chain triglyceride oil. Infants received more than 100 ml of human milk per kilogram of body weight per day beginning on the first or second day of birth and continuing until discharge from the hospital (an average of nine weeks).

At six months of age, infants who received the human milk supplemented with DHA and AA were better at problem-solving and were better able to discriminate between familiar and unfamiliar objects compared with infants in the control group.

“There is growing evidence that DHA and AA have specific functions related to memory and problem-solving,” said Christine Henriksen, PhD, lead author of the study from the Department of Nutrition at the University of Oslo, Norway. Dr. Henriksen and her colleagues point out that these functions are critical for being able to focus, be attentive, learn, and process information. Further research is needed to understand the long-term impact of supplementing with fatty acids on school performance and attention capacity later in life.

Ensure you eat your EFAs

Babies are dependent on breast milk and/or fortified formula milk for DHA and AA, but there are other important sources of essential fatty acids (EFAs) to consider as the child grows older. In addition, recent research has shown that it is important for pregnant women to eat plenty of fatty acids in order to help optimize their baby’s brain function. You can find them in these sources:

• Fatty fish such as salmon, halibut, and tuna are good sources of DHA, which is also found in smaller amounts in eggs. Pregnant women should balance the need for fatty acids from fish with reducing exposure to mercury by limiting the amount of fish they eat and avoiding fish high in mercury content.

• AA is found in meat, chicken, and eggs.

• Some people may benefit from supplements that contain fatty acids. Check with your doctor about the appropriateness of using supplements to further enrich your diet.

(Pediatrics 2008;121:1137–45)

Healthnotes Newswire (July 31, 2008)—Low levels of vitamin D in the blood may increase risk of cardiovascular events such as a heart attack, according to two recent studies published in the Archives of Internal Medicine.

In addition to its critical role in bone development and maintenance, recent research has shown that vitamin D may be far more important for other aspects of health and disease prevention than was previously realized. In fact, research has linked low levels of vitamin D with chronic diseases such as cancer and multiple sclerosis. Now, new research suggests that inadequate vitamin D may increase the risk of heart attacks and death due to cardiovascular disease and other causes.

Investigating diet’s impact on heart health

In the Health Professionals Follow-up study, a study evaluating the associations between diet and the incidence of chronic disease, 18,225 men ages 40 to 75 were evaluated for their blood levels of vitamin D (measured as 25-hydroxyvitamin D [25(OH)D]) and subsequent risk of heart attack. After ten years of follow-up, 454 men had a heart attack or died from coronary artery disease. Men who had less than 15 nanograms per milliliter of the vitamin D measure had a 50% increased risk of having a heart attack compared with men whose blood levels were 30 nanograms per milliliter or higher.

In another study, 3,258 men and women (average age 62) who were scheduled for angiography because of suspected coronary artery disease were followed for subsequent cardiovascular death or death by another cause. People in the study had blood levels of vitamin D drawn at the time of angiography. After 7.7 years of follow-up, 737 people died and 463 of those people died from cardiovascular disease. People with the lowest levels of vitamin D—less than 13.3 nanograms per milliliter—had a higher risk of death from any cause, and a higher risk of death from cardiovascular disease compared with those people whose levels were greater than 28.3 nanograms per milliliter.

Vitamin D may help prevent heart disease by lowering blood pressure, decreasing calcification in the heart vessels, or by other mechanisms. However, the optimal daily level of vitamin D to prevent chronic disease and maintain health is still not known.

“Vitamin D deficiency has been related to an increasing number of conditions and to total mortality,” said Edward Giovannucci, MD, ScD, and his colleagues from the Harvard School of Public Health, Boston, Massachusetts. Dr. Giovannucci comments that the amount of vitamin D required for optimal health may be much higher than the current daily recommendation of 200 to 600 IU per day. This would be especially true for those with minimal sun exposure, added Dr. Giovannucci.

Getting enough vitamin D

Sources of vitamin D include the sun, food, and dietary supplements. People who live in sunny climates who wear less clothing and therefore allow more daily exposure of their arms and legs usually have higher levels of vitamin D compared with people who live in more northern or more cloudy climates.

Food sources of vitamin D are limited but include some fish such as salmon, mackerel, and tuna; cod liver oil; fortified milk; and fortified cereal products. Eggs, fortified margarine, some cheese, and other foods have small amounts of vitamin D.

Ask your doctor about how to get enough vitamin D from appropriate dietary changes or supplements based on your current health.

(Arch Intern Med 2008;168:1174–80; Arch Intern Med 2008;168:1340–9)

Healthnotes Newswire (July 31, 2008)—Women over 50 are usually reminded to have their bone density evaluated every couple of years, but many healthcare providers don’t know when to recommend this screening to men. To help pinpoint the right time for testing men’s bone density, a new review has identified the major factors that put men at risk for fracture from osteoporosis. The review, published in the Annals of Internal Medicine, analyzed the findings from 177 studies performed between 1990 and 2007 that assessed risk factors for osteoporosis-related fracture in men, and 20 studies that evaluated various screening tests for osteoporosis. The findings from a previous review were also included in the analysis.

What puts men at risk

It comes as little surprise that the two most important risk factors identified for men were the same as those for women: being over 70 years old and being thin (having a low body mass index). Other risk factors included sedentary lifestyle, having taken prolonged courses of steroid medications, weight loss, and having had a previous fracture due to osteoporosis. Androgen deprivation therapy, a prostate cancer therapy that reduces testosterone levels, was also found to significantly increase fracture risk.

Smoking was found to slightly increase fracture risk, while low dietary calcium from milk was not consistently associated with fracture risk. Drinking alcohol had no apparent effect on fracture risk or bone mineral density.

Although some studies identified rheumatoid arthritis, respiratory diseases such as asthma, and gastrointestinal disorders such as celiac disease as risk factors for low bone density and fracture, the evidence was not strong.

Are you a good candidate for screening?

Dual-energy x-ray absorptiometry (DEXA) is the current gold standard for diagnosing low bone density and osteoporosis in men and women. It is regularly recommended for women but less commonly for men, despite the fact that 25% of men over age 60 will have a fracture due to osteoporosis sometime in their lifetime.

A simple osteoporosis screening questionnaire involving age and weight as the only variables was found to be an accurate predictor of osteoporosis in men, and one study found that the strongest predictor for hip fracture risk was weight under about 150 pounds (70 kilograms).

“Osteoporosis in men is substantially underdiagnosed and undertreated in the United States and worldwide,” said lead study author Dr. Hau Liu of the Santa Clara Valley Medical Center in San Jose, California. “We determined that men of advanced age and low body weight are the best candidates for osteoporosis screening. Identifying other important risk factors, particularly weight loss, physical inactivity, corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy, can help healthcare providers select other men who are good candidates for screening.”

(Ann Intern Med 2008;148:685–701)

Healthnotes Newswire (July 24, 2008)—Potatoes, often thought of as just a starch, are actually an important source of potassium; provide modest amounts of calcium, magnesium, phosphorus, and sulfur; and have small amounts of zinc, boron, copper, manganese, and iron. Cooking them reduces their mineral content, however, and a new study found that many of potatoes’ nutritious minerals are lost when they are cut into small pieces and then boiled. More nutritional value can be preserved by cooking them whole.

Heat depletes

In the study, published in the Journal of Food Science, six varieties of potato were washed and peeled, then cut into small cubes or shredded into strips. The potato cubes and strips were either placed in cold water overnight or boiled for ten minutes. Soaking resulted in minimal potassium loss, but boiling the potato cubes cut their potassium content by about 50%. Boiling shredded potatoes cost even more potassium—about 75% was lost. When potatoes in either form were soaked and boiled, the results were the same as when they were only boiled.

Other minerals showed similar trends: about 50% of the shredded potatoes and about 30% of the cubed potatoes lost their original sulfur, magnesium, zinc, and manganese during boiling. The amounts of phosphorus and iron were also significantly lower after boiling. Calcium, copper, and boron content were not consistently affected.

This degree of potassium loss was more dramatic than that seen in previous studies using whole peeled potatoes. Other research has shown that zinc and iron are preserved when the potato is boiled whole with its skin intact.

Why potassium matters

Potassium is necessary for maintaining normal fluid balance, acidity, and heart rhythm, and a healthy body keeps potassium carefully balanced with sodium. Although potassium is abundant in fruits and vegetables, many people don’t get enough from their diets, especially relative to sodium, an imbalance that is linked to high blood pressure.

For people with kidney disease, too much potassium can be more of a concern than too little. Soaking potatoes in cold water before cooking them, known as leaching, is a common practice among people with kidney disease on potassium-restricted diets, but this study’s results suggest that leaching is unnecessary. Simply cutting the potatoes into small pieces and boiling them has the same potassium-depleting effect.

Most of us, however, can and should eat lots of potassium-rich foods, including tomatoes, sweet potatoes, winter squash, avocadoes, oranges, bananas, and, of course, potatoes. “Although cutting potatoes into small pieces is appealing because it reduces cooking time, it is appears that this is not the most nutritious way to prepare them,” said study co-author Dr. Shelley Jansky of the US Department of Agriculture. “People who want to get the most out of their potatoes should boil them whole and unpeeled, or consider other cooking methods like baking or roasting.”

(J Food Sci 2008;75:H80–5)

Healthnotes Newswire (July 24, 2008)—People with type 2 diabetes are more likely to suffer from memory problems, especially right after eating. A new study in Nutrition Research found that taking antioxidant vitamins with food can help people with diabetes offset the memory-robbing effects of a heavy meal.

Putting antioxidants to the test

Diabetes is characterized by higher than normal blood sugar (glucose) levels. Long-term elevations in blood sugar increase the body’s production of free radicals—tissue-damaging compounds that cause many of the complications of diabetes including eye and kidney damage, heart disease, and memory impairment. Eating a meal increases free radical production in the body, and people with diabetes are particularly prone to the negative effects of this sudden rise.

In the new study, 16 adults with diabetes, on separate occasions, were given a high-fat high-carbohydrate meal or the same meal plus 1,000 mg of vitamin C and 800 IU of vitamin E. After eating, they took a series of tests to measure memory capacity.

After eating the test meal alone, the people had a harder time remembering words and information presented to them. Taking antioxidant vitamins with the meal prevented this from happening. “In adults with type 2 diabetes, co-consumption of antioxidant vitamins minimizes meal-induced memory impairment, implicating oxidative stress as a potential contributor to these decrements,” said the study’s authors.

Upgrade your diet for better health and sharper memory

While taking supplements can be useful in the short term, it’s a good idea to eat healthful foods that are naturally rich in antioxidants and other substances known to combat diabetes like fiber, magnesium, and chromium.

• Eat lower-fat meals. Limit packaged and snack foods, and cook foods at home to control the amount of fat, sugar, and other processed ingredients that go into a meal.

• Use unprocessed foods in meal preparation. Skip “white foods” like flour, rice, bread, potatoes, and sugar. Whole grains may be substituted for processed ones; these will not have the same detrimental effects on blood sugar and memory function.

• Focus on antioxidant-rich foods. Great choices include berries, winter squash, cantaloupe, sweet potato, broccoli, tomatoes, oranges, pomegranate, artichoke, red grapes, nuts and seeds, sweet peppers, mango, legumes, whole grains, and dark green leafy veggies (kale, collards, chard).

(Nutr Res 2008;28:423–9)

Healthnotes Newswire (July 24, 2008)—The Journal of the American Medical Association reports that bright light may help improve symptoms caused by dementia such as altered moods, disturbed sleep, and the inability to carry out activities of daily living.

Dementia is a common condition worldwide, and Alzheimer’s disease is its most common form. Dementia impairs a person’s memory and ability to think normally and is often associated with changes in behavior, mood, sleep, and the ability to carry out activities of daily living such as bathing or eating. With few simple remedies available, these symptoms create challenges for people with dementia and their caregivers.

Testing showed some clear improvements

In this study, 189 elderly people with Alzheimer’s or other types of dementia were randomly assigned to receive bright light (indirect, ceiling-mounted, whole-day bright light), melatonin (2.5 mg per day), a combination of bright light and melatonin, or neither melatonin nor bright light. Treatments were given daily for an average of 15 months.

When compared with other treatments or no treatments, bright light was associated with no worsening of mental status, an improvement in depressive symptoms, and improved functioning. Melatonin alone improved the ability to fall asleep earlier and increased sleep duration but had an adverse effect on behavior and mood, and increased withdrawn behavior. Bright light plus melatonin improved sleep disturbances, improved agitated behavior and restlessness during sleep, and decreased the duration of awakenings during sleep.

The study’s authors concluded, “The simple measure of increasing the illumination level in group care facilities ameliorated symptoms of disturbed cognition, mood, behavior, functional abilities and sleep. Melatonin improved sleep, but its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects on mood.”

People with dementia need structure and safety

Caring for a person with dementia can be challenging, but the following tips may help make it easier:

• It is important for caregivers to work closely with people who are highly trained and familiar with the specific challenges of dementia, such as geriatricians and/or social workers. These professionals can educate caregivers about ways to improve symptoms and keep a person with dementia safe from harming themselves or others. Medications may help improve symptoms or slow the condition’s progression, but many needed changes are often behavioral or environmental.

• A structured, supervised environment is important for people with moderate to severe dementia who cannot care for themselves. A stimulating and caring environment can help them stay active and functional for a longer period of time.

• Consider the following safety precautious if you are caring for someone with dementia: lock doors so that he or she cannot leave the house unsupervised and get lost; keep car keys in an inaccessible place; and put safety latches on appliances such as ovens. It is also a good idea to get a medical alert bracelet for the person under your care to wear.

(JAMA 2008;299:2642–55)

Healthnotes Newswire (July 17, 2008)—Everyone knows that fish is good for you, but it turns out that some is better than others for certain health needs and goals.

A new study, published in the Journal of the American Dietetic Association, analyzed 30 species of wild and farmed fish and found that while wild fish is generally more healthful than farm-grown, fish such as salmon and trout still maintain a beneficial fatty acid profile. Other farmed fish, such as talapia, do not, so while these may be incorporated into a regular diet as an occasional inexpensive, low-fat protein source, people wanting to maximize disease-fighting health benefits from fish will opt in favor of those with a better balance of fatty acids.

The ratio is the real measure of risk

A wealth of research shows that eating fish rich in omega-3 fatty acids may help prevent and treat diseases such as heart disease, diabetes, inflammatory and autoimmune diseases, and some cancers. However evidence increasingly points to the ratio of omega-3 to the less discussed omega-6 fatty acids in the diet as the indicator of disease risk.

• Fish with an omega-3 to omega-6 ratio of greater than one are considered beneficial because of their effect on the fatty acid profile of the entire diet.

• Fish with a ratio of 0.5 or lower are considered not protective against disease.

As a polyunsaturated fat, omega-6 also plays a role in supporting health, as long as it is consumed in moderation.

The best fish for fending off disease

The authors of the study collected samples of commonly eaten fish—including tuna, snapper, mahi-mahi, cod, sole, halibut, haddock, talapia, swordfish, catfish, salmon, and trout—from distributors in the US and Chile, from fish farms in the US, Chile, Canada, Ecuador, Honduras, Norway, and New Zealand, and from supermarkets in the US. Some highlights of their findings include:

• Sockeye salmon, Coho salmon, Copper River salmon, and farmed rainbow trout had a beneficial fatty acid pattern—in other words, a high ratio of omega-3 to omega-6 fatty acids.

• Farm-raised Atlantic salmon had high levels of omega-3 fatty acids but their levels of omega-6 fatty acids were higher than those of the wild salmon, making their ratio slightly less favorable, though still healthy.

• Tuna, one of the most commonly eaten fish in the US, had a low level of omega-3 fatty acids, but it also had a low omega-6 level, so its ratio remained favorable.

• On the other end of the spectrum, farmed talapia and catfish had low levels of omega-3 and poor ratios of omega-3 to omega-6 fatty acids.

Balancing factors besides fatty acids also important

Of all the fish reviewed in this study, tilapia has received the most attention for its unfavorable fatty acid content. “All other nutritional content aside, the inflammatory potential of hamburger and pork bacon is lower than the average serving of farmed tilapia,” the article cautions. However, keep in mind that a fish not being highly protective against heart disease does not mean it needs to be avoided entirely. Other health factors, such as heavy metal contamination—which are high in otherwise healthful fatty fish like tuna, but low in less heart-healthy fish like tilapia—should also be taken into account.

To give the pros and cons of fish consumption some real world perpective, consider that eating moderate amounts of farmed tilapia is roughly equivalent to other staples of the average diet, and may be a reasonable option for some people. For those at risk for inflammatory diseases such as heart disease, fish with a good omega-3 to -6 ratio such as salmon or trout are the best choice.

(J Am Diet Assoc 2008;108:1178–85)

Healthnotes Newswire (July 17, 2008)—A new study has shown that education, combined with healthy behaviors such as eating fruits and vegetables each day, exercising, and keeping a food diary, are key ingredients for maintaining weight loss. While it is well known that such behaviors can help a heavy person lose weight, few large studies have looked at behavioral interventions for keeping weight off, which is critical for overweight people with high blood pressure or high cholesterol.

Healthy habits are key

The study, known as the Weight Loss Maintenance Trial, compared various strategies for maintaining weight loss over a 30-month period. All 1,684 participants were 25 years or older and were overweight or obese and taking medication for high blood pressure and/or high cholesterol. Each participant was encouraged to attend 20 weekly group educational sessions, restrict calories, use a daily food diary, exercise daily at a moderate to intense level, and follow the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy foods, and limits saturated fat, total fat, and cholesterol.

After two and a half years, people who lost the most weight (18.7 pounds [8.5 kg] or more) had, on average, attended more weekly educational sessions (15), exercised more (159 minutes per week), kept more food diary records (4.2 records per week), and eaten more fruits and vegetables (3.6 servings per day).

“A combined emphasis on dietary intake and physical activity is important to both short- and long-term weight loss goals,” said the study’s author, Jack Hollis, PhD, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. “Behavioral strategies to modify these health behaviors are important components of weight-loss interventions because they emphasize the individual’s ability to monitor and regulate behavior, and target the barriers to both initial weight loss and long-term maintenance.”

Smart slimming strategies

People with high blood pressure, high cholesterol, and diabetes are at high risk for cardiovascular diseases such as stroke or heart attack, but weight control can help prevent and treat these conditions. There is no quick fix for losing weight or maintaining weight loss. If you are overweight, start by eating right, exercising, keeping stress in check and seeing your doctor.

Here are some tips for losing weight and keeping it off:

• Eat an abundance of fruits and vegetables based on recommendations from your healthcare provider. Limit saturated fat and sugar and avoid “empty” calories that provide little or no nutrition such as some processed foods, snacks, and beverages.

• Get enough exercise. A report from the Institute of Medicine suggests that adults need 60 minutes of moderate physical activity every day in order to optimize health and prevent disease; children need a minimum of 90 minutes.

• Keep a diary to track your daily food and calorie intake and help you learn how to identify eating patterns and make healthy choices throughout the day.

• Join a support group for health lifestyle behaviors or share the experience with friends and family, which can help improve your chances for success.

(Am J Prev Med 2008;35:118–26)

Healthnotes Newswire (July 17, 2008)—If you are chronically tired, getting moving might be just the thing to put some pep in your step. A new study has found that exercise can improve energy and lessen feelings of tiredness in people who suffer from persistent fatigue.

The effects of exercise on people with certain chronic medical conditions (heart disease and cancer, for example) are well documented, but less is known about its role in improving stamina in people suffering from fatigue without an underlying disease. The new study aimed to determine how exercise affects feelings of fatigue and energy in young people with fatigue unrelated to a medical condition.

In the study, published in Psychotherapy and Psychosomatics, 36 sedentary people with persistent fatigue ranging in age from 18 to 35 were assigned to a low- or moderate-intensity exercise group, or to a no-treatment control group. The low-intensity group worked out on a stationary bicycle at 40% of their peak oxygen consumption (roughly equivalent to walking at a leisurely pace) and the moderate intensity group at 75% of their peak oxygen consumption (about the same as walking at a fast pace), for 30 minutes three times per week for six weeks.

Slow and steady the best bet for persistent fatigue

People in the low- and moderate-intensity exercise groups had a 20% improvement in energy levels after six weeks compared with levels at the beginning of the study. Low-intensity exercise decreased feelings of fatigue by 65%, compared with 49% in the moderate-intensity group. The changes in fatigue and energy levels were unrelated to changes in aerobic fitness. The authors suggested that energy and fatigue improvements are due to the direct effects of exercise on the central nervous system.

Exercise professionals agree

“I have found that maintaining a consistent exercise routine keeps me feeling well balanced and energized,” says Rachel Weisz-Nesshoever, Aerobic and Fitness Association of America certified group exercise instructor in Narragansett, Rhode Island. “Exercise has a way of lifting the spirits and combating fatigue. Sometimes people who are chronically tired tend to avoid exercising. What they don’t realize is that—if it’s done right—exercise can actually give you more stamina and energy to do the things you want to do.”

(Psychother Psychosom 2008;77:167–74)

Healthnotes Newswire (July 10, 2008)—Good news for your little juice lovers: Although several studies have suggested that drinking fruit juice might contribute to overweight in children, a review of 21 studies found that the link was not strong. “There is no systematic association between consumption of 100% fruit juice and overweight in children and adolescents,” said the study’s authors in the American Journal of Lifestyle Medicine.

The origins of overweight

While genetics play a role, diet and exercise patterns are also intimately involved in maintaining healthy weight. In a previous study, one researcher found that children who drank more than 12 ounces of fruit juice per day were more likely to be overweight than children who drank less juice. Since juice is the drink of choice for many youngsters, the new study compiled evidence from studies concerning juice consumption and overweight in children to try to answer the question: Does drinking juice make kids fatter?

Only 6 of the 21 studies reviewed found a relationship between drinking 100% fruit juice and overweight in children, none of which were based on a nationally representative sample. Those that found a relationship did so only in adolescent girls and children who were overweight to begin with. The other 15 studies—5 of which were based on nationally representative samples—found no relationship between drinking juice and becoming overweight.

The authors concluded, “The data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of fruit juice may be an important strategy to help children meet the current recommendations for fruit.”

“As the mother of one child who wants nothing to do with juice, and another who would drink it all day long, it is a relief to read this new study. I feel like it’s one less thing for me to stress about as a mom,” said Erin Goodman, founder of the Rhode Island Birth Network.

The importance of addressing obesity

According to the 2003-2004 National Health and Nutrition Examination Survey (NHANES), 17% of all children and adolescents are overweight. Among 2 to 5 year olds, the prevalence increased from 7 to 14% between 1988 and 2004; similar increases were seen among 6- to 19-year-olds in this time span, with an increase in the percentage of overweight children from 11 to 19%.

Says Dr. Matthew Baral, medical director of Hamilton Elementary School Clinic in Phoenix, “Eating the whole fruit is preferable to the juice, since the release of sugar in the bloodstream is somewhat blunted by the fiber in whole fruit. When consuming juice, dilute it with water to lessen the amount of sugar the child is getting.”

Help your child maintain a healthy weight

Here are some simple things that parents can do to help keep kids’ weight in a healthy range:

• Snack on fruits and veggies—Make a big fruit salad on the weekend; store in the fridge and eat all week. Keep ready-to-eat cut-up vegetables on hand for quick snacks. Baby carrots, snap peas, broccoli, and cauliflower are easy to eat on the go.

• Get moving in your free time—Set a positive example by making exercise a priority for the whole family.

• Limit TV time—Kids who watch more TV or eat while watching TV are more likely to become overweight.

• Avoid processed foods—Packaged snacks can contain hidden fats and sugar. Opt for home-baked goods to satisfy the urge to snack.

(AJLM 2008;doi:10.1177/1559827608317277)